Autism

Prevalence, Definitions, and Characteristics

Autism is a disorder characterized by severe impairments of social, emotional, and intellectual functioning. Children with autism are often described as having great difficulty communicating and interacting with and responding to other people. Many individuals with autism also exhibit stereotypic behavior such as self-stimulating behaviors; bizarre speech patterns such as repeating the words of other people over and over again (echolalia); and disruptive behavior; sometimes including self-injury (Scott, Clark, & Brady, 2000; Simpson & Zionts, 2000). Children with autism are typically identified before the age of 3. Frequently, parents are the first ones to become concerned when their infants do not respond positively to being touched and held closely, and when language does not develop along the common developmental milestones.

Individuals with autism make up approximately .15% of the school-age population, or 1.7% of the students served under IDEA (U.S. Department of Education, 2005). The prevalence of autism appears to be increasing in recent years, although the reasons for this are not completely clear (Simpson & Zionts, 2000). Related diagnostic categories include autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s disorder, and pervasive developmental disorder (American Psychiatric Association, 2000). The current diagnoses indicate that individuals with autism may function along a continuum of severe to mild disabilities, and that educational accommodations vary according to an individual’s functioning level. Individuals with severe autism may have limited to no expressive and receptive language, while individuals with milder forms of autism may have developed more sophisticated communication as in the case of those with Asperger’s disorder. Although symptoms and severity level vary among individuals with autism, communication and social competence are typically the two greatest challenges. Some individuals—perhaps as many as 75% of those with autism—also have mental retardation (Heward, 2006). Individuals with Asperger’s disorder, however, are often very intelligent. Because of this variability, autism is often referred to as autism spectrum disorder. (Simpson & Zionts, 2000).

Classroom Adaptations for Students with Autism

Classroom adaptations for individuals with autism can be classified into adaptations for those with severe autism and for those with mild autism. Individuals with severe autism may function similarly to those individuals with severe disabilities, and it is recommended that you try the suggested adaptations for individuals with severe disabilities. Conversely, individuals with milder forms of autism may be included more frequently into general education classes, and you may wish to consider using modifications recommended for students with mild disabilities, including learning disabilities and behavior disorders. In both cases, work closely with special education teachers and parents. This collaboration ensures that IEP goals and objectives are being addressed, and that you have assistance in interacting with students. The following adaptations are also helpful for including students with autism in general education classes.

Establish Effective Communication

Discuss optimal communication patterns and design communication strategies with special education teachers, parents, and peers. Strategies might include sign language or Augmentative and Alternative Communication (AAC) methods. For example, in the following scenario, Tony is a young boy with autism who does not have language, but does communicate with an AAC procedure referred to as the Picture Exchange Communication System (PECS). PECS teaches students to use pictures and symbols to initiate and respond to communication from others (Bondy & Frost, 2002).

Develop Social Competence

Unless you make a point to design behavior plans with the student’s IEP team and implement these plans systematically you may find it easy to become overwhelmed by the student’s challenging behaviors (e.g., aggression, self-injury, hyperactivity, compulsive behaviors, self-stimulatory behaviors, or running away) (Ruble & Dalrymple, 1996). Teach students to wait their turn, share materials, and know when they need to be quiet and when they can talk. Teach them to use socially appropriate behaviors throughout the school day to help promote generalization of appropriate social behavior. Reward successive approximations, and work toward having students become more independent. Develop behavior management plans based on an analysis of student preferences and classroom dynamics.

Create a learning environment in which the student with autism feels comfortable, including a predictable schedule of daily activities, a pattern of events, and class routines. Use pictures to list the sequence of activities if the student is a nonreader, and allow the student to order the sequence if possible. If you change the class routine, prepare the student ahead of time to avoid undue stress.

One promising technique for improving social behavior is the use of social stories (Barry & Burlew, 2004; Gray & Garand, 1993). Social stories use simple sentences and pictures to demonstrate the desired social behavior and the feelings and reactions of others, such as, “When I return my tray after I have finished eating, my teacher is happy.” The Research Highlight feature demonstrates an application of social stories to improve the social functioning of students with autism in a middle school setting (Graetz, 2003).

Enlist the help of peers to reinforce socially appropriate behavior. Group students with autism with higher functioning students. Students with autism can be included successfully in cooperative learning groups when paired with partners who have been taught to communicate effectively with them in reading and science (Kamps, Leonard, Potucek, & Garrison-Harrell, 1995).

Watch for signs that the student is becoming stressed. Students with autism may react aggressively or withdraw completely under novel or stressful situations. Try to predict when the class demands might become stressful and attempt to eliminate that source of stress.

Finally, establish and maintain effective communication with all individuals who are in contact with students with autism. Communicate regularly with parents. Send home weekly or daily notes, short audiotaped messages, or a journal that travels back and forth from you to parents.

Classroom Scenario

Tony

Tony had a difficult first day in his inclusive kindergarten. His teachers saw his crying, tantruming, and acts of aggression, and, fortunately, realized that much of his behavior reflected not simply the fact that he had autism, but rather his inability to communicate in a new environment. His teachers used the Picture Exchange Communication System (PECS) to train him in socially appropriate ways to obtain what he wanted, using the six phases of the training program (Scott, Clark, & Brady, 2000). In the first phases, they determined that Tony enjoyed playing with a particular toy truck. When he reached for it, they placed the picture card of a truck in his hand, then guided him to give the picture to his teacher. The teacher immediately gave him the truck. In later phases, Tony was encouraged to go to a touch board for the picture, then discriminate the truck from other pictures, and then to build sentence structure by choosing first the “I want” card, followed by the picture of the desired object. In the fifth phase, Tony responds to “What do you want?” questions, and in the sixth phase, Tony uses the PECS cards to answer teacher questions, such as “What do you have?” or “What do you see?”

As Tony learns the PECS program, his tantruming and inappropriate behavior diminishes, and he learns socially appropriate ways of interacting with others. Other students use the PECS materials to interact with Tony. The PECS training continues to include additional language concepts, such as adjectives, verbs, and yes-no responses. Tony is learning important lessons for communicating and socializing with teachers and classmates.